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Home The Risks of Fully Reopening Schools – BuDS’ Guidance (Full Article)

The Risks of Fully Reopening Schools – BuDS’ Guidance (Full Article)

Lots of people are worried about the re-opening of schools to all pupils next week. BuDS has looked at all the recent scientific research and information to try to answer your questions. Read on for more…

This is the second of two articles about the re-opening of schools. It looks at the risk of re-opening schools. The first article looked at the scientific facts and opinions around children and Covid-19. There are links to the first article and other useful information at the bottom of this article. We will try to publish another article about colleges and universities later.

This is a very long article. If you want to skip the explanations and just read the headlines, please go down and read the ‘Conclusions’, below.

SOME STARTING FACTS

In thinking about the re-opening of schools, there are some facts which most people don’t know but which have to be known if the issue of school re-opening is to be properly understood.

The first unexpected fact is that the scientific data shows that children (under 16) and young adults (16+) are *less* likely to catch and spread Covid-19 than adults.1 This is because children and young people seem to be less susceptible to Covid-19.2 If it is harder for children and young people to catch Covid-19, it follows that it is also harder for them to spread it.

Many people assume that children are ‘natural’ spreaders of Covid-19 in the way that they are ‘natural’ spreaders of other diseases and viruses. But the scientific data says this is incorrect. So, most of the ‘common sense’ thinking about schools being ‘infection factories’ and children being ‘super-spreaders’ isn’t actually correct at all. You can read more about this in our other article about children and Covid-19 here: https://buds.org.uk/scientific-facts-around-children-and-covid-19/.

The second unexpected fact is that most adults and nearly all children who catch Covid-19 show no symptoms at all.3 This means that, unless you test everyone connected with a school before and after the school opens, it’s very hard to know what effect the re-opening actually had on the spread of Covid-19.4 The virus might have been spread silently to lots of people who showed no symptoms, or it might not have spread at all. This difficulty in seeing the impact of school re-openings has made it possible for both supporters and opponents of school re-opening to claim the science is on their side.

The third unexpected fact is that, when looking at the spread of Covid-19, the number of infected people in your area is much more important than whether schools are open or shut.5 If the overall number of infected people is low, then the risk of catching Covid-19 is also low, even if schools are open. Equally, if the number of cases is generally higher, then outbreaks can be expected in schools (and other places where people gather) if they are open. This risk of local outbreaks is why the Government and councils are bringing in local restrictions and lockdowns to stop the local level of infections from getting too high.

RE-OPENING SCHOOLS

Re-opening schools could be risky in two quite separate ways. One issue is the risk to public health in general – that fully re-opening schools will cause a spike or second wave of Covid-19 infections.6 The second issue is the risk to individual people such as pupils, teachers and family members, particularly adults and children who are at higher risk from Covid-19.7

We will look at these two risks separately, bearing in mind the three key facts mentioned above.

THE PUBLIC HEALTH RISK

Many people feel that fully re-opening schools will cause a spike or second wave of Covid-19 infections. They feel that staff, children, and young adults mixing together in school and parents meeting at school gates will all help to spread the virus. Finding out the facts, however, is very difficult.

A major recent study by the European Centre for Disease Prevention and Control8 looked at exactly this issue and is the best source of scientific guidance. Unfortunately, it said that there is conflicting scientific evidence about whether fully re-opening schools will increase the spread of Covid-19, with some studies saying it will and other studies saying it won’t.9 However, the study said that a number of EU countries which have already re-opened schools did not see significant spikes in Covid-19 infections, although this may be because those infected did not have symptoms.10

Another study of English schools by Public Health England looked at Covid-19 outbreaks in all open schools in the summer of 2020.11 This study found that outbreaks were uncommon in schools – only 30 outbreaks were found. This may be because schools only had small groups of staff and students during the period and strict infection precautions were easy to take.12 The likelihood of an outbreak in a school was most closely connected to the level of infection in the general community around the school, rather than anything connected to the school itself.13

Looking at all this together, BuDS’ view about the *public health* risks of re-opening schools is as follows. (See below for our views about the risks for individuals.)

If there are not many infected people in an area, fully re-opening schools is not particularly risky, because Covid-19 cannot spread if not many people have it. However, if the number of infected people in the general community starts to increase, then there *will* be outbreaks of Covid-19 at schools just as there will be at other places where people gather, like churches, offices and factories. These school outbreaks will involve both students and staff becoming infected and spreading the infection to families and friends with whom they are in contact. While most people will not be seriously ill (and many will show no symptoms at all), those people who are clinically at higher risk from Covid-19 who are cross-infected by staff and students, or who are themselves staff or students, may well die or have serious illnesses.

Unless students and staff are regularly tested, whether they have symptoms or not, outbreaks of Covid-19 at schools are likely to be ‘silent’, with most adults and nearly all children not showing any symptoms and not being ill. This means an outbreak at a school potentially could grow very quickly and involve lots of people without anyone becoming aware of it. This has been seen in other outbreaks at factories. In particular, unprotected people at higher risk of dying or being seriously ill if they catch Covid-19 might not realise that an outbreak has started at a school until they catch the virus. In fact, without routine testing, the school outbreak might be noticed only when the older and susceptible people catch the virus and show symptoms.

In public health terms, BuDS feels that local authorities and schools should be taking steps to closely monitor Covid-19 in their schools, by routine testing of large samples of staff, students and school visitors. Only in this way can outbreaks be detected quickly and steps taken to damp them down.

BuDS also feels that local authorities themselves should use their new public health powers to set and publish a firm limit of infections in the community beyond which schools must be closed or introduce strict infection-control precautions like face masks. There should be no confusion or vagueness about how and when public health measures need to change. In particular, local authorities should act on the advice of their Director of Public Health, without the intervention of party-political Councillors who may have a vested interest to support or oppose Government policy.

If public health controls like the ones we have described are used, BuDS feels the risk to *public* health from school re-opening seems to be manageable and reasonable. If these public health measures are not taken, then fully re-opening schools carries high risks to public health of silent outbreaks which could lead to large spikes in infection rates and the deaths or serious illness for many thousands of clinically susceptible people. Local authorities will be responsible if this happens, as the power to act lies with them.14

In addition, the risk to some *individuals* from school re-opening is currently unacceptably high – see next section for details.

THE RISK OF SCHOOL RE-OPENING TO INDIVIDUALS

Government guidance is that schools should NOT use the most effective infection-control measures, such as face masks and social distancing of more than 2 metres between students and staff.15 Schools seem to be following this guidance. This leaves schools relying mainly on frequent handwashing and limiting contact between students by timetable and circulation changes. Schools are also using ‘bubbles’ for infection control. However, many of the ‘bubbles’ are too large to be of any practical use.

Scientific studies clearly show that face coverings are highly effective in reducing the transmission of Covid-19 between individuals, especially when they are in close contact.16,17 By choosing to NOT use face masks, schools are deliberately choosing to significantly increase both the risk of infections happening in the school and the impact of those infections. Should school outbreaks occur, as they will if community levels of infections rise, then BuDS feels that Academy Trusts, Governors and senior management may well be personally and collectively liable for injuries and deaths which occur if it can be proven that they were negligent in protecting student and staff’s health and safety.

BuDS strongly urges all schools to follow World Health Organisation guidance on face masks rather than that published by the Government. This guidance is that all pupils over 12, and all staff, should always wear the appropriate face mask or covering.18 Alongside routine large-scale testing of staff and students to detect outbreaks in their early stages, BuDS feels that face mask use would enable schools to open more safely and in a much more sustainable way.

RISKS TO STUDENTS

Children under 16 and young adults can catch Covid-19, but it seems to be a lot harder for them to catch it compared to older adults.  When children and young adults do catch Covid-19, they are much less likely than adults to get seriously ill, although a few do get seriously ill. Hardly any children or teenagers have died of Covid-19.19,20 In fact, children and young adults are much more likely than older adults to show no symptoms at all if they catch Covid-19. They will probably appear completely normal, even if they are in fact infected.21

This means that students are not at high risk from Covid-19 if schools fully re-open. This is not because they will not catch Covid-19 – because some inevitably will. It is because young people have a very low risk of serious illness, and virtually no risk of death, even if they do catch Covid-19. The Chief Medical Officer was narrowly correct when he said that *students* would be safe at school.

Some children and young adults have medical conditions which make them extremely clinically susceptible to Covid-19. These young people were advised by Government to ‘shield’ or self-isolate themselves during the pandemic until shielding was ‘paused’ on 1 August. Government guidance issued on 18 August said that clinically extremely susceptible children and young adults should go back to school, although no reason was given for this.22 On 21 August, the Government underlined that school attendance is mandatory from September.23 However, as explained below, the Government have since retreated from this position.

BuDS has not been able to locate any clinical or scientific evidence that it is generally safe for extremely clinically susceptible children and young people to return to school. The Government’s advice that they should return to school is not supported by any published evidence.

Government guidance on extremely clinically susceptible children and young people now states that “If children are not able to attend school because they are following clinical and/or public health advice, you will not be penalised.”24. BuDS therefore strongly recommends that parents of extremely clinically susceptible children and young people speak to their GP, hospital clinic or consultant before sending them back to school. You should show the clinician a copy of the school’s risk assessment for children and explain how the child will be attending school, i.e. with or without a face mask, socially-distanced or not, etc. The key question to ask clinicians is: ‘if my child catches Covid-19 from a staff member or another child, is there a high risk that they will be seriously ill or even die’. If the answer is yes, then you have the right to withhold your child from school and cannot be penalised.25

RISKS TO STAFF

The scientific evidence is that school staff are far more at risk from Covid-19 than students.26

A Public Health England study of all schools open in the summer of 2020 found 30 outbreaks in schools. Of those schools which had an outbreak, the majority of people infected were staff, not students, and staff seem to have infected each other or students much more than students infecting staff or other students.27 The study concluded that it was more effective to stop staff getting infected and spreading the virus than it was to stop students getting infected and spreading the virus.28

Another study by the Office for National Statistics in April 2020 suggested that education staff were roughly at the same risk of dying from Covid-19 as workers in health or care settings, such as nurses or care workers. This underlined that, for staff, a school is a high-risk workplace.

The PHE study shows that school staff are at highest risk of catching Covid-19 from other staff, although they can be infected by students too.29 This emphasises the need for school staff to follow the same sensible precautions in their workplace as similar staff would do in their workplace – such as wearing face coverings or masks in staff rooms and communal areas, observing social distancing and frequent hand washing.

BuDS’ research shows that nearly a fifth of school staff are over 50 years of age and nearly 8% are BAME. This puts them at higher clinical risk of dying or being seriously ill if they catch Covid-19.30 While there do not seem to be any firm figures on how many school staff were shielding, BuDS is aware of several staff in nearly every local school in this position (You can find out more about who is at higher clinical risk from Covid-19 here: https://buds.org.uk/how-dangerous-is-covid-19-if-you-catch-it/)

In these circumstances, it is impossible to understand why Government guidance says that all school staff, even those who are extremely clinically susceptible, should NOT wear face masks.31. This guidance flies in the face of World Health Organisation guidance for teachers32,33 and Government guidance for staff in other workplaces and high-risk settings, such as health and care workers.34

BuDS has not been able to locate any clinical or scientific evidence that it is generally safe for extremely clinically susceptible staff to return to school. The Government’s ruling that school staff should not wear face masks is not supported by any published evidence.

BuDS therefore strongly recommends that school staff who were advised to shield or who might be at higher clinically risk from Covid-19 should ask their employer to prepare an individual risk assessment for them under the Health & Safety at Work Acts before they return to work. You should also speak to your GP, hospital clinic or consultant and ask them: ‘If I catch Covid-19 from a staff member or child, is there a high risk that I might be seriously ill or even die?’. Unless the answer is a clear no, then you should let the school know and ask them how they plan to keep you safe at work.35 Health & Safety law requires employers to “provide appropriate personal protective equipment (PPE) and training in its usage to their employees wherever there is a risk to health and safety that cannot be adequately controlled by other means”.36 BuDS feels that schools as employers cannot legally refuse to allow staff to wear face masks if there is a good reason why they should.

Given the PHE study mentioned above, it is also obvious that school staff wearing face masks will protect students, who might otherwise catch Covid-19 from staff.37

RISKS TO PARENTS AND FAMILY MEMBERS

There does not seem to be any good scientific evidence about the risks to parents and family members from students starting to attend school. However, scientific data shows that children (under 16) and young adults (16+) are less likely to catch and spread Covid-19 than adults. This is because children and young people seem to be less susceptible to Covid-1938. If it is harder for children and young people to catch Covid-19, it follows that it is also harder for them to spread it.

However, if children and young people get into close contact with large groups of people, the overall risk of them catching and spreading Covid-19 rises to about the same, or slightly higher, risk of adults catching and spreading Covid-19. Given that schools (on government advice) are not taking effective steps to prevent students getting into close contact with large groups of other students, this means that students are about the same risk to their parents and family members as adults who are active in their workplaces or local community. Students are not a higher risk than adults of this kind.

If, on the other hand, schools require children and young adults to take sensible precautions against catching Covid-19, such as wearing face masks and social distancing, the risk of students catching and spreading Covid-19 falls significantly. This would help prevent the spread of Covid-19 from students to their families and wider households.

Because children can catch Covid-19 and give it to other people, adults at higher risk of death or serious illness if they catch Covid-19 should take sensible precautions to protect themselves against catching Covid-19 from their children, once the children have returned to school. These precautions include social distancing and wearing PPE facemasks (and/or asking the children to wear face coverings). Those at higher risk include shielding people and those aged over 60, such as grandparents (more info here: https://buds.org.uk/how-dangerous-is-covid-19-if-you-catch-it/)

CONCLUSIONS

PUBLIC HEALTH: BuDS feels the risk to public health from school re-opening can be manageable and reasonable with extra precautions like large scale sample testing of students and staff and automatic closure if levels of infection rise in the local community. But, if these extra public health measures are not taken, fully re-opening schools carries high risks to public health of silent outbreaks which could lead to large spikes in infection rates and the deaths or serious illness for many thousands of clinically susceptible people.

STUDENTS: Students are not at high risk from Covid-19 if schools fully re-open, because young people have a very low risk of serious illness, and virtually no risk of death, even if they do catch Covid-19. The Chief Medical Officer was narrowly correct when he said that *students* would be safe at school. However, students who are more clinically at risk from Covid-19 are at high risk at school and should not return without clinical advice and, possibly, taking extra precautions like wearing face masks.

STAFF: The scientific evidence is that school staff are far more at risk from Covid-19 than students. Many staff are at higher clinical risk of dying or being seriously ill if they catch Covid-19. It is impossible to understand why school staff are being prevented from wearing face masks. School staff who are more clinically at risk from Covid-19 should not return to work without clinical advice and, possibly, taking extra precautions like wearing face masks.

PARENTS & FAMILY: Students are about the same infection risk to their parents and family members as adults who are active in their workplaces or local community. Students are not a higher risk than adults of this kind. Adults at higher risk of death or serious illness if they catch Covid-19 should take sensible precautions to protect themselves against catching Covid-19 from their children once the students have returned to school. This includes older people over 60.

MORE INFORMATION

To learn more about the people who are more likely to die or have serious illness if they catch Covid-19, use this link: https://buds.org.uk/how-dangerous-is-covid-19-if-you-catch-it/

To learn more about how face coverings and face masks can protect you, and read our recommendations about using them, click this link: https://buds.org.uk/buds-guidance-on-face-coverings-and-masks-31-july-2020/

To learn more about higher-infection-risk people and places that you should avoid, use this link: https://buds.org.uk/high-risk-places-and-people-to-avoid-if-you-are-older-or-shielding/

To read our article about the risks to children from Covid-19, use this link https://buds.org.uk/scientific-facts-around-children-and-covid-19/

FINALLY

You can freely share this post using social media. However, please do not share only parts of the post or alter it so that it looks like your own work. If you do, BuDS may take legal action against you.

 

Sources

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1166/5893024#

https://www.ecdc.europa.eu/en/publications-data/children-and-school-settings-covid-19-transmission

https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30249-2/fulltext

https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/911267/School_Outbreaks_Analysis.pdf

https://www.who.int/news-room/q-a-detail/q-a-children-and-masks-related-to-covid-19

https://www.legislation.gov.uk/uksi/2020/750/made

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/datasets/coronaviruscovid19relateddeathsbyoccupationenglandandwales

https://www.who.int/westernpacific/news/speeches/detail/virtual-press-conference-on-covid-19-in-the-western-pacific

https://www.bbc.co.uk/news/live/world-53577222

https://www.gov.uk/government/publications/actions-for-schools-during-the-coronavirus-outbreak/guidance-for-full-opening-schools

https://www.who.int/publications/i/item/WHO-2019-nCoV-IPC_Masks-Children-2020.1

https://www.who.int/publications/i/item/considerations-for-school-related-public-health-measures-in-the-context-of-covid-19

https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak

https://royalsociety.org/-/media/policy/projects/set-c/set-c-facemasks.pdf?la=en-GB&hash=A22A87CB28F7D6AD9BD93BBCBFC2BB24

https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

https://explore-education-statistics.service.gov.uk/find-statistics/school-workforce-in-england

https://www.unison.org.uk/at-work/education-services/key-issues/covid-19-closures/#heading-3

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/911188/PHE_PPE_guide_for_community_and_social_care_settings_AUG_2020.pdf

 

References

[1] https://www.ecdc.europa.eu/en/publications-data/children-and-school-settings-covid-19-transmission

[2] https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html

[3] https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

[4] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/911267/School_Outbreaks_Analysis.pdf

[5] Ibid.

[6] https://www.ecdc.europa.eu/en/publications-data/children-and-school-settings-covid-19-transmission

[7] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/911267/School_Outbreaks_Analysis.pdf

[8] https://www.ecdc.europa.eu/en/publications-data/children-and-school-settings-covid-19-transmission

[9] Ibid.

[10] Ibid.

[11] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/911267/School_Outbreaks_Analysis.pdf

[12] Ibid. p11/12

[13] Ibid. p2 and p12

[14] https://www.legislation.gov.uk/uksi/2020/750/made

[15] https://www.gov.uk/government/publications/actions-for-schools-during-the-coronavirus-outbreak/guidance-for-full-opening-schools

[16] https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak

[17] https://royalsociety.org/-/media/policy/projects/set-c/set-c-facemasks.pdf?la=en-GB&hash=A22A87CB28F7D6AD9BD93BBCBFC2BB24

[18] https://www.who.int/news-room/q-a-detail/q-a-children-and-masks-related-to-covid-19

[19] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/911267/School_Outbreaks_Analysis.pdf

[20] https://www.ecdc.europa.eu/en/publications-data/children-and-school-settings-covid-19-transmission

[21] Ibid.

[22] https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

[23] https://www.gov.uk/government/publications/what-parents-and-carers-need-to-know-about-early-years-providers-schools-and-colleges-during-the-coronavirus-covid-19-outbreak/what-parents-and-carers-need-to-know-about-early-years-providers-schools-and-colleges-in-the-autumn-term

[24] Ibid.

[25] Ibid.

[26] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/911267/School_Outbreaks_Analysis.pdf

[27] Ibid. p2 and p7-10

[28] Ibid. p2 and p12

[29] Ibid. p2 and p9

[30] https://explore-education-statistics.service.gov.uk/find-statistics/school-workforce-in-england

[31] https://www.gov.uk/government/publications/actions-for-schools-during-the-coronavirus-outbreak/guidance-for-full-opening-schools

[32] https://www.who.int/news-room/q-a-detail/q-a-children-and-masks-related-to-covid-19

[33] https://www.who.int/publications/i/item/considerations-for-school-related-public-health-measures-in-the-context-of-covid-19

[34] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/911188/PHE_PPE_guide_for_community_and_social_care_settings_AUG_2020.pdf

[35] https://www.unison.org.uk/at-work/education-services/key-issues/covid-19-closures/#heading-3, other union advice may vary so should be checked individually – however it is likely that it will take a similar form to this

[36] https://www.hse.gov.uk/contact/faqs/ppe.htm

[37] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/911267/School_Outbreaks_Analysis.pdf

[38] https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html